In 1911, Aaron Rosanoff published among the first pedigree studies of psychiatric illness, and the first ever in the United States, claiming that the neuropathic constitution was transmitted in as a ...Mendelian recessive disorder. In 1917, Abraham Myerson harshly critiqued that study, focusing on the very wide phenotypic definition of neuropathic constitution. Here, I describe Rosanoff and Myerson's backgrounds, the details of Rosanoff's study, and Myerson's critique and put this controversy in the context of the history of psychiatric genetics, emphasizing four themes: a) the close interrelationship between psychiatric diagnosis and models of genetic transmission, b) the strong attraction of Mendelian models to psychiatric geneticists after their 1900 rediscovery, c) the controversy about whether familial transmission of psychiatric illness is largely homogeneous or heterogeneous, and d) the methods taken by researchers to the problems of psychiatric genetics that typically emerged as part of their broader approach to the nature of psychiatric illness.
Over 12 years (1887-1899), in his second through sixth editions of his textbook Psychiatrie: Ein Lehrbuch für Studierende und Ärzte, Emil Kraepelin created, through an iterative, self-examining ...process, his mature concepts of Verrücktheit (paranoia) and Paranoide Formen Dementia Praecox. I seek in this essay to show this skilled nosologist at work. Four themes were prominent. First, Kraepelin used symptoms throughout, but he transitioned from superficial phenomenon (delusional themes) to those he considered more pathognomonic: disorganized fantastical delusions vs organized, nonbizarre delusions. Second, he increasingly emphasized the distinction between delusions arising from misinterpretations of real events vs delusions arising from hallucinations. Third, the putative causes of the disorder became more important as he came to understand Verrücktheit from a psychological and developmental perspective, whereas dementia paranoides (the precursor to paranoide formen dementia praecox) resulted from pathological brain changes. Fourth, Kraepelin appreciated the importance of disease course, but he initially lacked adequate data to elucidate it. As his research program developed, he used the well-recognized disease of general paralysis of the insane as a paradigm and correlated symptoms, modes of delusion formation, and presumed mechanisms of disease with course and outcome. Patients with slowly developing, referential, nonbizarre delusions without hallucinations were typically stable for years with minimal deterioration. Patients with rapidly developing, poorly organized, fantastical delusions emerging from prominent hallucinations tended to deteriorate quickly. Using conceptual tools first proposed by Kahlbaum and Hecker, Kraepelin developed his concepts of Verrücktheit and paranoide formen dementia praecox using an exploratory, conceptual, and data-gathering process in which each syndrome was defined in contrast to the other and, in addition to a core focus on disease course, multiple additional levels of clinical inquiry were included.
Reflections on philosophy of psychiatry Kendler, Kenneth S.
World psychiatry,
June 2024, 2024-Jun, 2024-06-00, 20240601, Letnik:
23, Številka:
2
Journal Article
In his 1873 monograph “La Folie Héréditaire,” the French Alienist Legrand du Saulle (LdS) first outlined his understanding of hereditary factors in insanity and then described in detail the theory of ...Hereditary Madness (HM) that emerged from the writings of his mentor Bénédict Morel. This form of insanity was thought to arise only in families with neuropathic traits. Degeneration theory, proposed by Morel, postulated a within‐family “evolution” of increasingly severe psychopathology, typically beginning with mild neuropathic traits and associated idiosyncrasies, and progressing over generations to hereditary madness, mental retardation, epilepsy, and eventual sterility. LdS took strong positions in favor of (i) the heterogeneous transmission of mental illness within families, (ii) consideration of both direct and collateral relatives, and (iii) the inheritance of a predisposition to illness, not the illness itself. He carefully examined the wide range of psychopathology and physical stigmata that occurred in what he called “inheritors” of the neuropathic trait. A unique feature of his work was the use of familial patterns of psychopathology to define a psychiatric disorder. While the theory of HM did not gain wide popularity outside of 19th century France, the concept of neuropathic traits was used extensively in early 20th century psychiatric genetics.
This article explores the nature of psychiatric genetics research conducted in asylums in Western Europe in the mid‐19th century through an examination of four studies published 1841 to 1864 from ...Great Britain, France, and Germany. They all utilize asylum records to determine if patients had a hereditary predisposition (HP) to mental illness. A diverse range of topics were investigated, with most attention on whether men or women are more likely to transmit, or are more sensitive to the receipt of, an HP. When significant sex effects were seen, they consistently found women to be more likely to transmit and/or more sensitive to the receipt of an HP. Other questions explored included: (a) the relationship between an HP and recurrence rates; (b) the degree of homogeneity versus heterogeneity of transmission of specific mental illnesses in families; (c) the level of HP among different forms of mental illness; and (d) differences in the proportion of psychiatric patients with an HP as a function of their religion. While the method of assessment of familial/genetic risk was relatively crude, even at this early stage in the history of psychiatric genetics, investigators were asking thoughtful questions about the nature and clinical impact of that risk.
In this paper, we characterize major depression (MD) as a complex dynamic system in which symptoms (e.g., insomnia and fatigue) are directly connected to one another in a network structure. We ...hypothesize that individuals can be characterized by their own network with unique architecture and resulting dynamics. With respect to architecture, we show that individuals vulnerable to developing MD are those with strong connections between symptoms: e.g., only one night of poor sleep suffices to make a particular person feel tired. Such vulnerable networks, when pushed by forces external to the system such as stress, are more likely to end up in a depressed state; whereas networks with weaker connections tend to remain in or return to a non-depressed state. We show this with a simulation in which we model the probability of a symptom becoming 'active' as a logistic function of the activity of its neighboring symptoms. Additionally, we show that this model potentially explains some well-known empirical phenomena such as spontaneous recovery as well as accommodates existing theories about the various subtypes of MD. To our knowledge, we offer the first intra-individual, symptom-based, process model with the potential to explain the pathogenesis and maintenance of major depression.
Alcohol use disorders (AUD) is well known to aggregate in families and is associated with socioeconomic status (SES). The objective was to study the effect of education, income and neighborhood SES ...in adulthood on AUD, and to explore whether the potential associations were confounded by shared familial factors, by using a co-relative control design.
Data on AUD was drawn from the Swedish inpatient and outpatient care registers; prescription drug register; and crime data. Through national population registers we collected information on income, education and neighborhood SES at age 25, 30, 35 and 40 years in all individuals born in Sweden between 1950 and 1980. Each sex-specific stratum consisted of approximately 750,000-1,200,000 individuals, who were followed for AUD for a mean follow-up time ranging between 10 and 15 years until the end of 2013. Cox proportional hazards models were used to investigate the risk of AUD as a function of income, education and neighborhood SES in the general population and in pairs of first cousins and full siblings within the same sex, who differed in their exposure to the SES measure.
Higher educational level, higher income and higher neighborhood SES were all associated with a reduced risk for AUD for both males and females in all ages. The potentially protective effect remained but was attenuated when comparing pairs of first cousins and full siblings.
High educational level and income in adulthood, as well as high neighborhood socioeconomic status, may represent protective factors against alcohol use disorders, even when shared familial factors, e.g. childhood socioeconomic status and genetic factors, have been taken into account.
This article examines the relationship between the early efforts of alienists to understand the role of heredity in the etiology of insanity in the 19th century and the parallel efforts of the ...nascent discipline of medical genetics. I review three monographs on general medical genetics: Adams in 1814, Steinau in 1843, and Lithgow in 1889. Numerous parallels were seen between their writings and those of their contemporary alienists working on mental disorders including (i) an emphasis on the transmission of the liability to illness rather than the illness itself, (ii) discussions of the homogeneous versus heterogeneous nature of familial transmission of disease, (iii) the relative value of direct versus indirect hereditary effects, (iv) the role of mothers versus fathers in transmitting liability, (v) possible environmental sources of familial clustering, and (vi) the transmission of age at onset of illness. All three medical genetic authors noted that insanity was among the more heritable of human disorders. Furthermore, Lithgow noted the importance of heritable influences on the non‐psychotic forms of psychiatric illness rarely seen in asylums. This survey demonstrates substantial consilience in the topics of interest and conclusions of the nascent general medical and psychiatric genetics' communities in the 19th century.
First-rank symptoms (FRS), proposed by Kurt Schneider in 1939, subsequently became influential in schizophrenia diagnosis. We know little of their prehistory. How often were FRS described before 1939 ...and in which countries and time periods? Which FRS was most frequently noted?
Forty psychiatric texts from 37 authors, published 1810-1932, were identified that described FRS. In a systematic subsample, half of the textbooks examined contained such descriptions with little differences between countries or over time. Somatic passivity was most commonly noted, followed by thought insertion, thought withdrawal, and made actions. This pattern resembled that reported in recent studies of schizophrenia. A novel term-delusions of unseen agency-was seen in psychiatric texts and then found, from 1842 to 1905, in a range of official reports, and psychiatric, medical, and general audience publications. The Early Heidelberg School (Gruhle, Mayer-Gross, Beringer) first systematically described "self-disturbances" (Ichstörungen), many of which Schneider incorporated into FRS.
From the beginning of Western descriptive psychopathology in the early 19th century, symptoms have been observed later described as first-rank by Schneider. A term "delusion of unseen agency"-closely related to Schneider's first-rank concept-was popular in the second half of the 19th century and described in publications as prominent as the Encyclopedia Britannica and New England Journal of Medicine. The descriptions of these specific symptoms, with substantial continuity, over more than 2 centuries and many countries, suggest that an understanding of their etiology would teach us something foundational about the psychotic illness.
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